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News from The Hilltop Institute at UMBC

Hilltop Releases Issue Briefs
on IRS Form 990 Schedule H and on Community Building

The Hilltop Institute’s Hospital Community Benefit Program has just released two new issue briefs in its Hospital Community Benefits after the ACA series, funded by the Robert Wood Johnson Foundation and the Kresge Foundation. The briefs are being published simultaneously as companion briefs.

Schedule H and Hospital Community Benefit—Opportunities and Challenges for the States, is a collaboration between Kevin Barnett, DrPH, MCP, Senior Investigator at the Public Health Institute, and Martha Somerville, JD, MPH, Hilltop’s Hospital Community Benefit Program Director. It discusses key federal community benefit reporting requirements developed by the Internal Revenue Service (IRS) as Form 990, Schedule H and explores the opportunities and challenges these present to state officials and policymakers, both as a reporting framework and as an informational resource.

Community Building and the Root Causes of Poor Health discusses hospital community building activities and their importance in addressing the root causes of poor health and disability. It explores hospital community benefit activities that go beyond the provision of health care services to focus on “upstream” social, economic, and environmental factors—education, employment, income, housing, community design, family and social support, community safety, and the environment—that are major contributors to community health. IRS Form 990, Schedule H is the vehicle hospitals use to report these activities.

Both briefs address community building reporting issues.

The first issue brief in the series, The Emerging Federal Framework (January 2011), provided historical background on federal hospital community benefit policy, outlined the new requirements described in the Affordable Care Act (ACA), and identified new challenges and opportunities for state and federal decision makers.

Building on State Experience (April 2011), took a closer look at three aspects of community benefits affected by the ACA §9007, “Additional Requirements for Charitable Hospitals”—community health needs assessment, hospital financial assistance and billing and collection policies, and community benefit reporting and oversight strategies—and considered each of these issues against a backdrop of federal and state experience and practice.

The third brief, Partnerships for Community Health Improvement (February 2012), discussed a variety of options for collaboration in assessment, planning, priority setting, and implementation of health improvement initiatives; provides examples of diverse models already in place; and examined their impact on the communities in which they occur.

Hilltop's Hospital Community Benefit Program is the central resource created specifically for state and local policymakers who seek to ensure that tax-exempt hospital community benefit activities are responsive to pressing community health needs. The program provides tools for state and local policymakers who would encourage nonprofit hospitals and other stakeholders to adopt collaborative, effective activities and programs to improve community health. Martha H. Somerville, JD, MPH, directs the program, which is funded for three years through the generous sponsorship of the Robert Wood Johnson Foundation ( and the Kresge Foundation (

To learn more about the program, contact Martha Somerville.


The Hilltop Institute at the University of Maryland, Baltimore County (UMBC) is a non-partisan health research organization dedicated to improving the health and wellbeing of vulnerable populations.  Hilltop conducts research, analysis, and evaluations on behalf of government agencies, foundations, and nonprofit organizations at the national, state, and local levels.  Hilltop is committed to addressing complex issues through informed, objective, and innovative research and analysis.

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